title: White-coat effect among older patients with suspected cognitive impairment: prevalence and clinical implications.
abstract: OBJECTIVE
  To evaluate the prevalence of white-coat effect (WCE), and its association with individual anxiety and insight of disease, among older patients evaluated for suspected cognitive impairment.
  
  
  METHODS
  This prospective cohort study, conducted in an Alzheimer Evaluation Unit, involved patients aged 55 years or older with suspected cognitive impairment. WCE was defined as a difference of at least 20 mmHg in systolic or 10 mmHg in diastolic blood pressure (BP) measured either by a physician during the visit or by a nurse (before and after the visit), compared with home self-blood pressure measurement (SBPM). Severity of cognitive impairment was evaluated through the Mini-Mental State Examination (MMSE); the Clinical Insight Rating Scale (CIR) and the Guidelines for the Rating for Awareness Deficits (GRAD) were used to evaluate the subject's insight; anxiety disorder was evaluated using the seven-question Generalized Anxiety Disorder scale (GAD-7).
  
  
  RESULTS
  Among 273 subjects, prevalence of WCE was 52%, 32.6% and 30.4%, according to physician and nurse BP measurements, respectively (p = 0.000). Prevalence of WCE did not differ between patients diagnosed with and without dementia, but was higher among patients with than in those without anxiety disorder (70.7% vs 38.2%, p = 0.000). Positive relations were observed between severity of anxiety and insight of disease, which were both inversely related with severity of cognitive impairment.
  
  
  CONCLUSIONS
  WCE is extremely common and is correlated to individual anxiety and insight of disease among older outpatients with suspected cognitive impairment; overestimation of hypertension severity might lead to unnecessary drug treatment and greater health costs in this setting.
authors.affiliation: SCDU Geriatria, Dipartimento Discipline Medico-Chirurgiche, ASO San Giovanni Battista, Molinette, Torino, Italy. mario.bo@unito.it
authors.forename: Mario
authors.initials: M
authors.lastname: Bo
authors.forename: Bo
authors.initials: B
authors.lastname: Mario
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Massaia
authors.forename: Massaia
authors.initials: M
authors.lastname: Massimiliano
authors.forename: Chiara
authors.initials: C
authors.lastname: Merlo
authors.forename: Merlo
authors.initials: M
authors.lastname: Chiara
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sona
authors.forename: Sona
authors.initials: S
authors.lastname: Alessandro
authors.forename: Antonella
authors.initials: A
authors.lastname: Canadè
authors.forename: Canadè
authors.initials: C
authors.lastname: Antonella
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Fonte
authors.forename: Fonte
authors.initials: F
authors.lastname: Gianfranco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology*; D001294:Attitude to Health; D001795:Blood Pressure Determination / Q000379:methods / Q000451:nursing / Q000523:psychology*; D003704:Dementia / Q000453:epidemiology* / Q000523:psychology; D005189:False Positive Reactions; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index